Menopause and Common Dermatoses: A Systematic Review

Abstract

Background

Menopause is a universal physiological transition, marked by a decline in estrogen, which has important effects on skin and mucosal health. The impact of menopause and menopausal hormone therapy (MHT) on chronic dermatoses remains incompletely defined.

Objective

The aim was to investigate the relationship between menopause, MHT, and common dermatological conditions.

Methods

PubMed, Embase, and Web of Science were searched from inception to September 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies evaluated menopause or MHT in relation to alopecia, psoriasis, acne, rosacea, melasma, and hidradenitis suppurativa (HS). Investigational cohorts largely consisted of menopausal women, although participant characteristics varied. Data on study design, population, hormonal status, and dermatological outcomes were extracted and synthesized.

Results

A total of 40 studies met inclusion criteria. Alopecia, particularly frontal fibrosing alopecia (FFA) and female pattern hair loss (FPHL), showed the strongest postmenopausal associations, with most cases presenting after menopause and earlier or surgical menopause conferring greater risk. Psoriasis frequently persisted or worsened after menopause, though objective assessments are limited. Acne and rosacea generally improved, whereas melasma showed mixed outcomes, including greater extra-facial involvement post menopause. HS responses to menopause were inconsistent. MHT was linked to increased risk of FFA and rosacea, whereas findings for other dermatoses were more variable or absent. Most of the studies involved MHT formulations that are less commonly used in current clinical practice.

Conclusion

Menopause influences the onset and course of several chronic dermatoses, while data on MHT remain more limited and inconsistent. Dermatologists should consider menopausal status and hormone therapy exposure when evaluating skin disease. Longitudinal, dermatology-focused studies—particularly those integrating diverse populations and updated hormone therapies—are needed to inform individualized care.

Key Points

Menopause has a notable impact on common dermatological conditions, with a strong association between menopausal status and various forms of alopecia.

Hormone-responsive dermatoses, including acne, psoriasis, rosacea, melasma, and hidradenitis suppurativa, exhibit variable responses to menopause and menopausal hormone therapy.

Significant gaps remain in our understanding of how hormonal changes and therapies impact cutaneous disease.

Introduction

Menopause is defined as the permanent cessation of menstruation, confirmed after 12 consecutive months without a menstrual period, and characterized by a significant and sustained decline in estrogen levels due to the end of ovulatory function [1]. Estrogen plays a central role in skin homeostasis by promoting collagen synthesis, maintaining hydration and elasticity, regulating sebum production, and modulating inflammation [2]. The loss of this hormone leads to a range of noticeable skin and mucosal changes. Common complaints include dryness of the skin and mucous membranes, which can manifest as xerosis, pruritus, and vulvovaginal atrophy [3]. Vasomotor symptoms such as hot flashes and night sweats may overlap with or exacerbate hyperhidrosis [3]. These symptoms are closely tied to estrogen deficiency and can significantly affect quality of life.

Beyond these well-recognized changes, hormonal shifts during menopause may also alter the course of chronic dermatoses [2]. For example, acne may persist or develop in midlife due to shifts in the estrogen-to-androgen ratio [4]. Other hormonally influenced conditions, such as hidradenitis suppurativa (HS), may also be impacted. Evidence suggests that combined oral contraceptives may delay onset or reduce severity of HS, raising important questions about how diminished estrogen in menopause—or hormone therapy with menopausal hormone therapy (MHT)—might influence disease activity [5, 6].

Despite these clinical observations, dermatological research on menopause remains limited. This gap is partly a legacy of the decline in menopause-focused study following the Women’s Health Initiative (WHI), which raised concerns about the safety of MHT due to its reported links to breast cancer and cardiovascular disease [7]. In the years since, evidence-based consensus guidelines from leading menopause societies have clarified that, for most females, benefits of MHT outweigh risks when initiated within 10 years of menopause—particularly for managing vasomotor symptoms and preventing osteoporosis [8]. However, persistent misinformation, stigma, and limited coverage of menopause in medical training and practice have contributed to the ongoing neglect of this topic.

This systematic review aims to synthesize current evidence on the impact of menopause and MHT on common dermatological conditions. By identifying consistent patterns and highlighting key gaps in the literature, this review seeks to increase understanding of how hormonal changes influence skin disease.

This systematic review was not registered in PROSPERO or any other review registry.

Methods

Search Strategy/Eligibility Criteria

A comprehensive literature search was conducted using three online databases, PubMed, Web of Science, and Embase from inception until September 2024. Additionally, a manual search of references from pertinent articles was completed to identify studies missed by computer search. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [9]. The full search strategy is detailed in Table 1.

Table 1.

Database search strategy

PubMed (("Menopause" [Title/Abstract] OR "Menopausal" [Title/Abstract] OR "Postmenopause" [Title/Abstract] OR "Postmenopausal" [Title/Abstract] OR "Perimenopause" [Title/Abstract] OR "Perimenopausal" [Title/Abstract] OR "Menopausal Transition" [Title/Abstract]) OR ("Hormone Replacement Therapy" [Title/Abstract] OR "HRT" [Title/Abstract])) AND ("Psoriasis" [Title/Abstract] OR "Acne" [Title/Abstract] OR "Rosacea" [Title/Abstract] OR "Seborrheic Dermatitis" [Title/Abstract] OR "Dermatitis" [Title/Abstract] OR "Eczema" [Title/Abstract] OR "Atopic Dermatitis" [Title/Abstract] OR "Hidradenitis Suppurativa" [Title/Abstract] OR "Common Dermatoses" [Title/Abstract] OR "hair loss” [Title/Abstract] OR "hair growth” [Title/Abstract] OR "hair regrowth” [Title/Abstract] OR "alopecia" [Title/Abstract] OR “androgenic alopecia" [Title/Abstract] OR "melasma" [Title/Abstract])

EMBASE ('menopause':ti,ab OR 'menopausal':ti,ab OR 'post menopause':ti,ab OR 'postmenopausal':ti,ab OR 'perimenopause':ti,ab OR 'perimenopausal':ti,ab OR 'menopausal transition':ti,ab) OR ('hormone replacement therapy':ti,ab OR 'hrt':ti,ab) AND ('psoriasis':ti,ab OR 'acne':ti,ab OR 'rosacea':ti,ab OR 'seborrheic dermatitis':ti,ab OR 'dermatitis':ti,ab OR 'eczema':ti,ab OR 'atopic dermatitis':ti,ab OR 'hidradenitis suppurativa':ti,ab OR 'common dermatoses':ti,ab OR 'hair loss':ti,ab OR 'hair growth':ti,ab OR 'hair regrowth':ti,ab OR 'alopecia':ti,ab OR 'androgenic alopecia':ti,ab)

WEB OF SCIENCE (TS=("menopause" OR "menopausal" OR "post menopause" OR "postmenopausal" OR "perimenopause" OR "perimenopausal" OR "menopausal transition") OR TS=("hormone replacement therapy" OR "HRT")) AND TS=("psoriasis" OR "acne" OR "rosacea" OR "seborrheic dermatitis" OR "eczema" OR "atopic dermatitis" OR "hidradenitis suppurativa" OR "alopecia" OR "androgenic alopecia" OR "common dermatoses") Search refined by Document Types: Article

To maintain a focused and systematic approach, our search strategy was limited to six conditions—alopecia, psoriasis, acne, rosacea, melasma, and HS—identified in the literature as common chronic dermatoses in postmenopausal women that may be hormonally influenced [2]. Studies were eligible if they examined the association between menopause and/or MHT and any of these conditions. Eligible studies included females of any age, specifically those who were premenopausal, perimenopausal, or postmenopausal, and investigated the impact of menopause on the onset, severity, or progression of these dermatoses. Studies reporting the prevalence of menopause, early menopause, or surgical menopause among affected individuals were also included. Additionally, studies examining the relationship between hormone replacement therapy (HRT)/MHT and the aforementioned dermatological conditions were included. Exclusion criteria encompassed case reports, case series, reviews, abstracts, editorials, and publications not written in English.

Data Extraction

Covidence (Melbourne, Australia), a central online reference manager for systematic reviews, was utilized. Duplicates were removed, and two reviewers (BK and KR) independently screened titles and abstracts for eligibility. Full-text articles were then reviewed, and discrepancies between reviewers were resolved through discussion and consensus, with a third reviewer (SM) consulted as needed. For each included study, the year, study design, sample size, patient population, data source, and primary results were extracted. To measure risk of bias and study quality, three reviewers (LF, AS, and AE) independently ranked each study in accordance with the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria [10]. Studies were graded with roman numerals to indicate the hierarchy of study designs, and letters to represent the strength of recommendations.

Outcomes

The primary outcome assessed the relationship between menopause, MHT and common dermatoses. Given the significant heterogeneity among studies, meta-analysis was not feasible.

Results

Literature Identification

A total of 2594 studies were identified across three databases. After removing duplicates, 1657 studies remained for title and abstract screening. Of these, 514 studies were selected for full-text review. Ultimately, 40 studies met inclusion criteria. The PRISMA flow diagram illustrating the selection process is presented in Fig. 1. Summaries of the included studies evaluating the associations of menopause and MHT with common dermatoses are presented in Tables 2 and 3, respectively.

Fig. 1.

PRISMA flow chart illustrating the study selection process. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Table 2.

Studies examining the impact of menopause on common dermatoses

Dermatoses	Study	Data source	Study type	Study participants (women)	Results/outcome	OCEMB score*
Psoriasis	Wu et al., 2016 [34]	Nurses’ Health Study Health Study I (1996–2008) and II (1991–2005)	Prospective	163,763 women with and without psoriasis	No difference in risk based on age at menopause, age at natural menopause, and type of menopause (surgical vs. natural menopause)	IA
Psoriasis	Xiao et al., 2024 [30]	United Kingdom Biobank (2006–2010)	Prospective	142,443 postmenopausal women with and without psoriasis	Earlier natural menopause and shorter reproductive years are associated with higher risks of psoriatic diseases in a dose-dependent manner Age at natural menopause after 55 years led to a 34% risk reduction in late-onset psoriasis The relative impact of age at natural menopause on late-onset psoriasis was found to be greater than that of some established risk factors, such as smoking and obesity	IA
Psoriasis	Xhaja et al., 2014 [32]	Survey Study at "Nene Tereza" University Hospital, Tirane, Albania (2012)	Cross-sectional	45 women with psoriasis (20% smokers)	36% of women reported that hormonal changes (puberty or menopause) exacerbated their psoriasis (p < 0.05)	IIIB
Psoriasis	Mowad et al., 1998 [33]	Survey Study at Psoriasis treatment center, Hospital of the University of Pennsylvania	Retrospective	248 women (63 perimenopausal)	48% reported worsening of psoriasis during menopause, 50% reported no change, and 2% reported improvement More patients’ disease worsened than expected during menopause (p = 0.001) Majority of patients taking hormonal replacement noted no change in their psoriasis No significant difference between surgical and natural menopause	IIIA
Psoriasis	McLaren et al., 2011 [31]	The Health Improvement Network (THIN) database	Retrospective	1,757,214 women of reproductive age	Psoriasis was associated with an increased RR of early menopause (<45 years; RR 2.21, 95% CI 2.02–2.42, p < 0.01) and premature ovarian failure (<40 years; RR 2.35, 95% CI 2.03–2.72, p < 0.01)	IIIB
HS	Kromann et al., 2014 [54]	Survey Study in Denmark and the Netherlands (1981–2001)	Cross-sectional	116 women (61 postmenopausal) with HS	48% of women reported that menopause improved their symptoms, 38% reported no change, and 15% reported worsening	IIIB
HS	Fernandez et al., 2020 [52]	Survey Study of Patients with HS across three HS specialty clinics in North America	Cross-sectional	279 women (43 postmenopausal) with HS	16.3% of women reported that menopause improved their symptoms, 44.2% reported no change, and 39.5% reported worsening There was an inverse relationship between the severity of HS symptoms during menses and menopause (p = 0.02)	IIIB
HS	Barth et al., 1996 [53]	Leeds General Infirmary in England	Cross-sectional	66 women (9 postmenopausal) with HS	100% of postmenopausal women reported symptoms either persisted or developed after menopause Of the postmenopausal women, eight had HS prior to the onset of menopause, and one developed HS post menopause	IIIB
Acne	Perkins et al., 2012 [38]	Survey study shopping done in US, England, Italy, and Japan	Case-control	2895 women with or without acne	Postmenopausal women have less acne than age-matched controls There was a negative association between acne severity and years post menopause	IIIB
Acne	Collier et al., 2008 [39]	Survey Study at University of Alabama, (2006)	Cross-sectional	540 women (315 postmenopausal) with and without acne	Age 40–49: 26.3% of women had acne Age 50 and older: 15.3% of women had acne Acne was more prevalent in females among all ages (≥20)	IIIB
Acne	Cunliffe and Gould,1979 [40]	Leeds, England	Cross-sectional	1066 women with and without acne	Among women >40, prevalence of clinical and physiological acne declines with age Clinical acne was more prevalent in males under 18, but higher in females after 23	IIIA
Alopecia (FFA)	Buendía-Castaño et al., 2018 [15]	Single Medical Center in Spain (2014–2016)	Case-control	312 women (298 post menopause) with or without FFA	Patients with FFA have an earlier age of menopause (47.7 years) compared to age-matched controls (49.7 years, p = 0.01). This indicates a 7% increased risk of FFA for each year after menopause	IIIB
Alopecia (FFA)	Maldonado Cid et al., 2020 [11]	Trichology unit of Hospital Universitario Infanta Sofía, Madrid, Spain	Retrospective	73 women (68 postmenopausal) with FFAl	93.2% of female patients had FFA onset after menopause	IVB
Alopecia (FFA)	Tosti et al., 2005 [12]	University of Bologna, Italy outpatient hair disorders consultation	Retrospective	14 postmenopausal women	The onset of FFA occurred after menopause in 100% of women	IVB
Alopecia (FFA)	Vañó-Galván et al., 2014 [16]	12 Medical Centers across Spain (1994–2013)	Retrospective	343 women (294 postmenopausal) with FFA	14% of patients reported early menopause, with a surgical cause in 9%. This is a high incidence rate when compared with the general population (6%) 13% of women, pre- and postmenopausal, reported a history of hysterectomy	IVB
Alopecia (FFA)	Carmona-Rodríguez et al., 2023 [13]	Hospital General Universitario in Spain (2010–2021)	Retrospective	296 women (246 postmenopausal) with or without FFA	84% of women were postmenopausal when diagnosed with FFA. Severity of FFA was associated with the time since symptom onset (rho = 0.26, p = 0.001)	IVB
Alopecia (FFA)	Suchonwanit et al., 2019 [14]	Thailand Hospital Center (1996–2017)	Retrospective	54 women (48 postmenopausal) with FFA	Onset of FFA was postmenopausal in 88.7% of patients. 3.7% of women reported a history of hysterectomy and oophorectomy; however, none had premenopausal onset of FFA	IVB
Alopecia (FFA)	Imhof et al., 2018 [17]	US Hospital Center (1992–2016)	Retrospective	148 women (129 postmenopausal) with FFA	13% of premenopausal women reported a history of oophorectomy	IVB
Alopecia (FFA)	Özkoca et al., 2022 [18]	İstanbul hair loss clinic (2019–2020)	Prospective cross-sectional	240 women (34 postmenopausal) with FPHL	14.2% of patients were postmenopausal. There was an association between menopause and advanced stage in FPHL (p = 0.012); however, menopause was not associated with a specific subtype (p = 0.090)	IIIB
Alopecia (FPHL)	Venning and Dawber, 1988 [19]	Dermatology clinic, hospital staff, and residents of elderly homes (mid-1980s)	Cross-sectional	564 women (310 postmenopausal) with and without AGA	The frequency of pattern hair loss increased significantly with age, particularly after the onset of menopause	IVB
Alopecia (FPHL)	Chaikittisilpa et al., 2022 [20]	Menopause Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand (2018–2019)	Cross-sectional	200 postmenopausal women with FPHL	Increased age and years post menopause were associated with increased incidence of FPHL	IIIB
Alopecia (FPHL)	Ali and Wojnarowska, 2011 [21]	Two primary care practices in the United Kingdom	Survey	758 postmenopausal women with or without FPHL	Significant increase in overall hair loss and increasing age. Advanced age had a less significant association with frontal hair loss (p < 0.05), and no association with temple hair loss	IIIB
Rosacea (ETR)	Yang et al., 2024 [45]	Dermatology Department of West China Hospital (2022–2023)	Prospective cohort	59 perimenopausal women with rosacea	Estradiol levels were significantly lower in individuals with moderate to severe ETR as compared to those with mild ETR	IVB
Rosacea	Wu et al., 2022 [44]	Nurses' Health Study II (1991–2005)	Retrospective	89,873 women (733 postmenopausal) with and without rosacea	Postmenopausal women had a lower risk of incident rosacea than premenopausal women (HR = 0.73, 95% CI 0.58–0.92)	IIA
Melasma	Handel et al., 2014 [48]	Dermatology outpatient clinic at Botucatu School of Medicine—UNESP, Brazil (2012–2013)	Case-control	414 women (61 postmenopausal) with and without melasma	Menopause was not significantly associated with melasma (p = 0.21)	IIIB
Melasma	Ritter et al., 2013 [50]	Dermatology clinic at Hospital de Clínicas de Porto Alegre, Brazil (2009–2010)	Case-control	39 women (32 postmenopausal women) with melasma	A non-statistically significant increase in the number of postmenopausal women in the extra-facial melasma group (82.1%) vs. control (69.2%) (p = 0.180) 82% of women in the patient sample had reached menopause	IIIA
Melasma	Hexsel et al., 2014 [49]	12 research centers across Brazil	Cross-sectional	929 women (163 postmenopausal) with melasma	14.2% of postmenopausal women had extra-facial melasma vs. 3.5% of non-menopausal women (p < 0.0001). 29.4% of postmenopausal women had improvement with menopause, 38% noted worsening, and 30.1% reported no change	IIA
Melasma	Mpofana et al., 2023 [51]	Three private dermatology clinics in Durban, South Africa	Cross-sectional	143 women (49 postmenopausal) with melasma	33% of women with melasma were postmenopausal. Menopause was associated with better quality of life among women with melasma	IIIB
Various dermatoses	Aboobacker et al., 2015 [58]	Outpatient records from dermatology clinic in South India (2005–2012)	Retrospective	8156 perimenopausal women	Most common dermatoses in perimenopausal patients were eczematous disorders (23.9%), urticaria (12.3%), and papulosquamous (10.9%). Of papulosquamous disorders, most common was psoriasis vulgaris (40.7%). Incidence of melasma was 1.1%	IVB
Various dermatoses	Pariath and Nair, 2019 [60]	Rural-based tertiary health care center in Gujarat, India	Cross-sectional	150 postmenopausal women	Psoriasis (9.18%), eczema (8.16%), melasma (7.14%). Hair disorders: AGA (10.27%), FPHL (34.24%)	IIIB
Various dermatoses	Wai, 2019 [59]	Myanmar Mercantile Marine College, Yangon, Myanmar	Cross-sectional	84 postmenopausal women	Eczema (21.4%), melasma (8.3%), psoriasis (11.9%)	IVB
Various dermatoses	Jha and Selvaraj, 2020 [61]	Tertiary care center in south India	Cross-sectional	150 postmenopausal women	Xerosis (78%), pigmentation changes (64%), hair thinning (58%), pruritus (46%)	IVB

AGA androgenic alopecia, CI confidence interval, ETR erythematotelangiectatic rosacea, FFA frontal fibrosing alopecia, FPHL female pattern hair loss, HR hazard ratio, HS hidradenitis suppurativa, OCEMB Oxford Centre for Evidence-Based Medicine, RCT randomized clinical trial, RR relative risk

^* Risk of bias and study quality were evaluated using the OCEMB Levels of Evidence tool. All included studies were observational unless otherwise specified as RCTs

Table 3.

Studies examining the impact of menopausal hormone therapy on common dermatoses

Dermatoses	Author, year	Data source	Study type	HRT type	Study participants	Results/outcome	Adverse effect	OCEMB score*
Psoriasis	Gang Min Go et al., 2023 [35]	Korea National Health Insurance Service database	Cohort study	NR	Postmenopausal women with no history of HRT (n = 918,980), less than 2 years of HRT = (n = 122,879), 2–5 years (n = 50,630), and 5 or more years (n = 38,252)	HRT at all time points (<2 years, 2–5 years, and 5> years) increases risk of psoriasis compared to non-HRT (HR = 1.13, 1.21, 1.22, respectively; 95% CI 1.09–1.17, 1.15–1.26, and 1.16–1.29, respectively)	NR	IIA
Psoriasis	Chan et al., 2021 [36]	WHI Hormone Therapy Trials	Cross-sectional	0.625 mg of conjugated equine or 0.625 mg estrogen and 2.5 mg MPA	Postmenopausal women with prior hysterectomy (n = 7577) or without (n = 11,734)	CEE alone had no statistically significant difference in psoriasis risk. CEE plus MPA had decreased risk compared to CEE alone (HR 0.77; p = 0.04)	NR	IIB
Psoriasis	Wu et al., 2016 [34]	Nurses' Health Study I and Il	Prospective analysis	Estrogen-alone, estragentriagesterone	Women aged 25–55 (n = 163,763), and subsample of those with incident psoriasis (n = 1253)	Current HRT users had a slightly increased risk of psoriasis (HR = 1.22, 95% CI 0.99–1.50), whereas past users had no increased risk	NR	IA
Psoriasis	Mowad et al., 1998 [33]	Survey Study at Psoriasis treatment center, Hospital of the University of Pennsylvania	Retrospective	NR	248 women (63 perimenopausal)	Majority of patients taking hormonal replacement noted no change in their psoriasis	NR	IIIA
Alopecia	Moreno-Arrones et al., 2018 [22]	NR	Case-control	NR	Postmenopausal women with alopecia (n = 335) and women without (n = 329)	There was a statistically significant association between HRT and alopecia (OR = 1.76, 95% CI 1.11–2.8)	NR	IIIA
Alopecia	Endo et al., 2023 [24]	NR	Clinical study	0.625 mg conjugated estrogen or 1.0 mg of 17-beta-E2 and 10 mg of dydrogesterone	Menopausal women taking HRT (n = 11)	HRT increased the telogen hair rate (p = 0.010, paired t test) at 3 months, improved frontal hairline thinning score (p = 0.008, Wilcoxon test), and increased the plucking strength (p = 0.013, paired t test) at 6 months	NR	IIB
Alopecia	Georgala et al., 2004 [25]	Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece	RCT	Topical lotion containing 0.03% estrogen valerate	Postmenopausal women with AGA (n = 65)	There was a statistically significant difference, in terms of decreased telogen rate and increased anagen rate, between women with HRT and without (p < 0.01)	Six patients complain of mild pruritus, redness, and/or scaling of the scalp	IIA
Alopecia	Singal et al., 2025 [23]	TriNetX database searched for all patients aged 0-90 with LPP and FFA between 2004–2024	Retrospective	Exogenous gonadocorticoids	Female (n = 34,238) patients with LPP and FFA	Females with exposure to HRT (OR = 3.87, 95% CI 3.31–4.52) and hormonal contraceptives (2.92, 2.65–3.22) vs. female controls had increased odds of LPP/FFA	NR	IIA
Alopecia/acne	Phillips et al., 2003 [29]	Safety surveillance data of Solvay Pharmaceuticals, Inc. between January 1989 and August 2002	Retrospective	Estratest and Estratest HS-esterified estrogen (1.25 mg and 0.625 mg, respectively) and methyltestosterone (2.5 mg and 1.25 mg, respectively)	Women (n = 1372) with adverse events (n = 2556)	Alopecia and acne reported as adverse events in 8.8% and 5.6%, respectively	Skin pigmentation changes, virilization (hirsutism, voice changes, acne)	IIA
Alopecia/acne	Phillips and Bauman, 1997 [28]	Safety surveillance data of Solvay Pharmaceuticals, Inc. between 1989 and 1996	Retrospective	Estratest and Estratest HS-esterified estrogen (1.25 mg and 0.625 mg, respectively) and methyltestosterone (2.5 mg and 1.25 mg, respectively)	Women (n = 568) with adverse events (n = 863)	Alopecia and acne are reported as adverse events in 34.3% and 17.9%, respectively	Hirsutism	IIA
Rosacea	Wu et al., 2022 [44]	Nurses’ Health Study II (1991–2005)	Retrospective	Estrogen and progestin combination; unopposed estrogen	Women (n = 89,873)	Increased incident rosacea risk associated with use of MHT (HR = 1.32, 95% CI 1.08–1.61). Longer duration of MHT use was associated with increased rosacea risk (HR = 1.78, 95% CI 1.26–2.51 for ≥ 10 years), and with MHT with oral conjugated estrogen (HR = 1.29, 95% CI 1.05–1.59)	NR	IIA
Melasma	Ritter et al., 2013 [50]	Dermatology clinic at the Hospital de Clinicas de Porto Alegre (Brazil) between September 2009 and July 2010	Case-control	NR	Patients with extra-facial melasma (n = 45) and without (n = 45). 86.7% were women with 82.1% in menopause	There was no statistically significant association between extra-facial melasma and hormone treatment	NR	IIIA

AGA androgenic alopecia, CEE conjugated equine estrogens, CI confidence interval, FFA frontal fibrosing alopecia, HR hazard ratio, HRT hormone replacement therapy, LPP lichen planopilaris, MHT menopausal hormone therapy, MPA medroxyprogesterone acetate, NR not reported, OCEMB Oxford Centre for Evidence-Based Medicine, OR odds ratio, RCT randomized clinical trial, WHI Women’s Health Initiative

^* Risk of bias and study quality were evaluated using the OCEMB Levels of Evidence tool. All included studies were observational unless otherwise specified as RCTs

Menopause, Menopausal Hormone Therapy, and Common Dermatoses

Alopecia

Among the dermatoses analyzed, alopecia emerged as the most studied condition. A strong association was identified between menopause and various forms of alopecia, particularly frontal fibrosing alopecia (FFA) and female pattern hair loss (FPHL). Multiple studies reported that the onset of FFA predominantly occurred after menopause, with postmenopausal women accounting for 84–100% of cases [11–14]. Notably, early menopause was also frequently linked to FFA. In a case-control study, Buendía-Castaño et al. found the average age of menopause among women with FFA to be 47.7 years, lower than 49.7 years in age-matched controls [15]. Similarly, Vañó-Galván et al. reported that 14% of patients with FFA experienced early menopause, compared to 6% in the general population [16]. Hysterectomy and/or oophorectomy were also associated with FFA, with reported incidences ranging from 3.7 to 13% among affected individuals [14, 17].

In the context of FPHL, both advancing age and the number of years since menopause were associated with increased incidence and severity of symptoms. Özkoca et al. found that menopause was linked to more advanced stages of the condition, although it did not correlate with any particular clinical subtype [18]. Similarly, Venning and Dawber and Chaikittisilpa et al. observed a higher prevalence of pattern hair loss with increasing age, especially after the onset of menopause [19, 20]. Ali and Wojnarowska also reported a clear upward trend in overall hair loss with age among a cohort of postmenopausal females [21]. In contrast, the relationship between age and frontal hair loss was less pronounced, and no association was observed with temporal hair loss [21].

The relationship between MHT and alopecia is complex and remains poorly defined due to limited and sometimes conflicting evidence. Importantly, different types of alopecia appear to respond differently to hormonal influences. In a multicenter case-control study of 335 females with FFA, Moreno-Arrones et al. found a significant association between FFA and various hormonal exposures, including pregnancy, HRT, and raloxifene, with HRT specifically linked to increased odds of FFA (odds ratio [OR] = 1.76, 95% confidence interval [CI] 1.11–2.8) [22]. More recently, a large retrospective study by Singal et al. further supported these findings, showing that females exposed to HRT (OR = 3.87, 95% CI 3.31–4.52), exogenous androgens (OR = 3.72, 95% CI 2.77–5.00), and hormonal contraceptives (OR = 2.92, 95% CI 2.65–3.22) had significantly higher odds of developing lichen planopilaris (LPP) or FFA compared to female controls [23].

In contrast, Endo et al. evaluated 11 females without any hair loss complaints before and after six months of HRT and observed improvement in frontal hairline thinning and increased hair plucking strength at six months [24]. They also noted a transient increase in the telogen hair rate at three months, which normalized by the 6-month mark [24]. Another study by Georgala et al. assessed 75 postmenopausal females with androgenic alopecia (AGA) treated with topical estradiol valerate 0.03% over 12 and 24 weeks. Both treatment groups showed an improved anagen-to-telogen hair ratio compared to placebo [25]. However, two participants developed postmenopausal uterine bleeding, with endometrial findings consistent with estrogen-induced proliferation, raising concerns about the safety of unregulated topical estrogen products. With the growing popularity of over-the-counter topical estrogen formulations marketed for “anti-aging,” there is an urgent need for better long-term safety data and physician oversight in this area [26, 27].

Finally, post-marketing safety data from Estratest^® and Estratest^® HS (esterified estrogens with methyltestosterone), prescribed for vasomotor symptoms from 1989 to 2002, documented alopecia as an adverse event in 8.8% of reported cases (n = 225) [28, 29]. Although some evidence suggests estrogen may improve hair loss, these findings underscore the potential for hormone-induced alopecia in certain conditions or with specific hormone formulations. Clinically, this highlights the importance of counseling patients that while estrogen therapy may benefit some types of alopecia, research is limited, and androgenic formulations can paradoxically worsen hair loss.

Summary: The evidence demonstrates a robust association between menopause and alopecia, with the overwhelming majority of FFA cases occurring postmenopausally and affected women experiencing menopause earlier than controls. Similarly, FPHL severity correlates with menopausal status, with advancing age and increasing years since menopause associated with more advanced disease stages and greater overall hair loss. The association between MHT and alopecia remains complex and inconsistent, with outcomes varying according to study design, hormone formulation, route of administration, and the specific alopecia subtype examined.

Psoriasis

Four studies investigated the relationship between menopause and psoriasis. In a prospective cohort study of postmenopausal women using UK Biobank data, Xiao et al. found that later age at natural menopause (ANM) and longer reproductive years were significantly associated with decreased risks of late-onset psoriasis and psoriatic arthritis [30]. Specifically, ANM after 55 years was inversely associated with the risk of late-onset psoriasis (34% reduction) and psoriatic arthritis (46% reduction) compared with ANM before 45 years (p < 0.001). The protective effect of later menopause on psoriasis risk exceeded that of established risk factors, including smoking and obesity [30]. Reciprocally, in a large population-based cohort of 1.7 million reproductive-age women, psoriasis was associated with an increased relative risk (RR) of early menopause (<45 years; RR 2.21, 95% CI 2.02–2.42, p < 0.01) and premature ovarian failure (<40 years; RR 2.35, 95% CI 2.03–2.72, p < 0.01) [31]. Xhaja et al. found that 36% of females with psoriasis reported a worsening of their condition due to hormonal changes, including menopause (p < 0.05) [32]. Similarly, Mowad et al. observed that 48% of females experienced exacerbation of psoriasis symptoms during menopause (p = 0.001), while 50% noted no change and only 2% reported improvement. The study found no meaningful differences between natural and surgical menopause [33]. In a large prospective cohort of 163,763 women from the Nurses’ Health Study I and II, Wu et al. observed a modestly increased risk of psoriasis with surgical menopause compared to natural menopause (hazard ratio [HR] = 1.19, 95% CI 1.01–1.40), although this association did not remain significant after correction for multiple testing [34]. Additionally, in contrast to Xiao et al. [30], Wu et al. [34] found no statistically significant association between age at menopause and psoriasis risk.

Four studies investigated the relationship between psoriasis and MHT. In a large population- based study of 1,130,741 postmenopausal females Gang Min Go et al. reported that MHT at all time points (<2 years, 2–5 years, and >5 years) increases risk of psoriasis compared to no MHT (HR = 1.13, 1.21, 1.22, respectively; 95% CI 1.09–1.17, 1.15–1.26, and 1.16–1.29, respectively) [35]. In contrast, Chan et al. demonstrated that postmenopausal females with an intact uterus using conjugated estrogen with medroxyprogesterone acetate (MPA) (n = 11,734) had a decreased risk of psoriasis (HR = 0.77, 95% CI 0.60–0.98, p = 0.04), whereas there was not a significant difference in the conjugated estrogen alone group (females with prior hysterectomy, n = 7577) [36]. Mowad et al. reported that among 63 females with psoriasis during menopause, the majority noted no improvement in their symptoms with MHT use [31]. Lastly, Wu et al. reported that current MHT users had a slightly increased risk of psoriasis, but these data were not statistically significant [34]. Clinically, this highlights the need for dermatologists to monitor psoriasis activity in women starting MHT, recognizing that certain formulations may exacerbate disease while others appear neutral, and to individualize management accordingly.

Importantly, psoriasis and menopause each independently increase risks for cardiovascular disease, metabolic syndrome, and mood disorders such as depression [37]. The combined burden of these overlapping risks remains underrecognized and underscores the need for coordinated prevention strategies. Additionally, we have identified no clinical trials evaluating whether long-term psoriasis therapies require dose adjustments as estrogen levels decline with menopause. In practice, treatments such as tumor necrosis factor inhibitors, interleukin-17 blockers, and methotrexate are generally maintained at the same doses, with modifications made only in response to disease activity.

Summary: Evidence on the relationship between menopause and psoriasis is mixed. Later menopause may reduce the risk of psoriasis and psoriatic arthritis, but other large cohorts show no clear association. Smaller survey studies consistently report that a substantial proportion of women perceive worsening or persistent symptoms during menopause, though objective assessment is lacking. Both conditions independently increase risks for cardiovascular disease, metabolic syndrome, and depression, yet this overlap is underrecognized and understudied. Data on MHT and psoriasis remain inconclusive.

Acne

Three studies explored the relationship between acne and menopause. In a survey study, Perkins et al. found that postmenopausal females reported less acne than age-matched controls, with acne severity showing a negative correlation with the number of years since menopause [38]. Similarly, Collier et al. observed a decline in acne prevalence with age, affecting 26.3% of females aged 40–49 and 15.3% of those aged 50 and above [39]. Cunliffe and colleagues also noted reduced acne in females over 40, underscoring the inherent challenge of distinguishing menopausal effects from those of natural aging, which reduces sebum output associated with acne pathogenesis [40–42].

There is a notable lack of research examining the impact of MHT on acne development. However, adverse event data from Phillips et al., evaluating females treated with esterified estrogens combined with methyltestosterone for vasomotor symptoms between 1989 and 2002, reported acne as an adverse effect in 5.6% (n = 142) of cases [28, 29]. This finding suggests that while menopause may be associated with a decreased risk of acne due to declining estrogen levels, certain MHT formulations—particularly those containing androgenic components like methyltestosterone—may reintroduce or exacerbate acne in susceptible individuals. Clinically, this highlights the importance of inquiring about MHT use, especially androgenic or testosterone-containing regimens, in postmenopausal women presenting with new-onset or worsening acne.

Although testosterone is not conventionally considered part of MHT, it is increasingly prescribed off label for the management of hypoactive sexual desire disorder (HSDD) in postmenopausal women [43]. With this rise in off-label testosterone use, dermatologists should be aware of its potential role in new-onset acne among menopausal women. Nonetheless, research directly evaluating the dermatological effects of exogenous testosterone in this population remains lacking.

Summary: Acne generally decreases after menopause due to hormonal changes and age-related declines in sebaceous activity. However, evidence on the effects of MHT is limited, with no studies evaluating conventional estrogen ± progestogen regimens. The growing off-label use of testosterone in menopause—typically through dose-adjusted male products prescribed for HSDD—may increase acne risk, but its impact in this population has not yet been studied.

Rosacea

Two studies examined the relationship between menopause and rosacea. In a large retrospective analysis of 5248 rosacea cases, Wu et al. found that postmenopausal females had a lower risk of developing rosacea compared to premenopausal females (HR = 0.73, 95% CI 0.58–0.92) [44]. However, a small prospective cohort study by Yang et al., involving 59 perimenopausal females with erythematotelangiectatic rosacea (ETR) identified an inverse association between estradiol levels and rosacea severity [45]. Females with moderate to severe ETR had significantly lower estradiol levels compared to those with mild disease [45]. Based on these findings, the authors proposed an “estradiol protective hypothesis,” suggesting that higher estrogen levels may enhance skin barrier function and reduce the likelihood of cutaneous disease, potentially lowering the risk of rosacea. However, this hypothesis is challenged by Wu et al.'s significantly larger trial, which showed a decreased incidence of rosacea in the postmenopausal period—which is characterized by reduced estrogen levels. Wu et al. also reported that MHT use among postmenopausal females was associated with an increased risk of rosacea (HR = 1.32, 95% CI 1.08–1.61) compared to non-users, with a non-significant trend toward higher risk with longer use (p = 0.26). Although, it is notable that Wu et al.’s cohort consisted of only White females, which limits its generalizability [45]. Clinically, this highlights the importance of recognizing MHT as a potential contributing factor in new or worsening rosacea.

Summary: Menopause appears to lower the risk of rosacea, as large cohort data show postmenopausal women have reduced incidence compared to premenopausal women. Notably, MHT use has been associated with increased rosacea risk, highlighting exogenous hormones as a potential modifiable factor. Dermatologists should consider both menopausal status and MHT exposure when evaluating new or worsening rosacea in midlife women.

Melasma

High-estrogen states such as pregnancy are well-established risk factors for the development of melasma [46]. Estrogen is believed to stimulate melanocyte activity, increasing melanin production—particularly when combined with ultraviolet (UV) exposure [46, 47]. Oral contraceptive pills (OCPs) containing both estrogen and progestin have also been linked to the onset and worsening of melasma [46]. As a result, discontinuation of hormonal contraceptives can be recommended as part of melasma management, with patients experiencing improvement over time.

Given this hormonal link, it would be reasonable to hypothesize that the menopausal period—characterized by a significant decline in estrogen and progesterone levels—might lead to an improvement in melasma. However, a case-control study by Handel et al. found no significant association between menopause and melasma [48]. In a large cross-sectional multicenter study in Brazil, Hexsel et al. reported varying effects of menopause on melasma, including improvement (29.4%), worsening (38%), and no change (30.1%) [49]. Interestingly, they noted a higher proportion of extra-facial melasma in postmenopausal females (14.2%) versus non-menopausal females (3.5%) (p < 0.0001).

This finding was echoed by Ritter et al., whose case-control study found that extra-facial melasma appeared to be associated with menopause, a family history of melasma, and a personal history of facial involvement. Notably, the study found no significant difference in hormone therapy use between melasma and non-melasma groups [50]. Finally, Mpofana et. al noted that melasma had less of a negative impact on quality of life after menopause as compared with prior to menopause [51]. Although these data found no clear overall association between menopause and melasma, two studies reported a higher prevalence of extra-facial melasma in postmenopausal females. Clinically, this highlights the importance of counseling that while high-estrogen states clearly drive melasma, the effects of menopause and MHT remain uncertain, and management should continue to focus on photoprotection and standard therapies.

Summary: While high-estrogen states such as pregnancy and oral contraceptives are recognized triggers for melasma, findings regarding menopause are inconsistent. Most studies do not demonstrate a definitive association, although some suggest greater extra-facial involvement in postmenopausal women. Evidence on MHT remains scarce, with no clear indication of its impact on melasma risk or severity.

Hidradenitis Suppurativa

Three studies examined the impact of menopause on HS, revealing variable and at times contradictory findings. Fernandez et al. reported that in most patients, HS symptoms either worsened or remained unchanged during menopause [52]. Notably, the study found a statistically significant inverse relationship between the severity of HS symptoms during menstruation and after the onset of menopause, suggesting that hormonal fluctuations may play a key role in symptom expression. Similarly, Barth et al. observed that HS symptoms persisted into menopause and afterward among a small cohort, further supporting the idea that menopause does not alleviate disease activity [53]. In contrast, Kromann et al. conducted a survey-based study in which 48% of participants reported an improvement in HS symptoms following menopause, while 38% experienced no change and 15% noted worsening, indicating a more favorable response in some individuals [54].

Emerging evidence points to the potential influence of hormonal therapies on HS outcomes. Studies have shown that combined oral contraceptives containing both estrogen and progesterone may delay the onset or reduce the severity of HS [5, 55]. These findings carry important implications for the use of MHT, suggesting that the hormonal environment may be modifiable in ways that benefit disease control. However, research examining the impact of MHT on the presentation and severity of HS is conspicuously lacking. More research is needed to clarify the role of estrogen and progesterone in HS pathogenesis, and to determine whether MHT could be a viable therapeutic adjunct in postmenopausal females with HS.

Critically, both HS and menopause are independently associated with increased metabolic risk. Women with HS have higher rates of metabolic syndrome and diabetes compared with controls, while the menopausal transition is linked to central adiposity, worsening insulin sensitivity, and elevated cardiovascular risk [56, 57]. Despite these overlapping burdens, no studies have specifically examined how menopause modifies metabolic comorbidities in HS, mirroring gaps seen in psoriasis research. Addressing this intersection is critical for improving long-term outcomes in affected women. Clinically, this highlights the importance of recognizing that while OCPs may influence HS premenopausally, there are no data to guide MHT use after menopause, and management should therefore prioritize guideline-based dermatological therapies while coordinating care for comorbid risks.

Summary: Findings on the impact of menopause on HS are inconsistent, with studies reporting persistence, worsening or improvement of symptoms. Hormonal therapies such as combined oral contraceptives may benefit disease control, but the role of MHT remains unstudied. Both HS and menopause independently increase metabolic risks, yet their combined impact has not been evaluated. Dermatologists should be aware of these overlapping burdens and coordinate care with other specialties to optimize outcomes.

Prevalence of Dermatoses

The literature on the prevalence of dermatoses in menopausal females remains limited, with only a handful of studies providing direct insight. The most comprehensive data come from Aboobacker et al., a large retrospective study involving over 8000 perimenopausal females, which identified eczematous disorders as the most common dermatoses (23.6%), followed by urticaria (12.4%) and papulosquamous disorders (10.7%) [58]. These findings are echoed by two smaller studies in postmenopausal females—Wai (n = 84) and Pariath and Nair (n = 150)—which also reported eczema as one of the most frequently observed conditions. Pariath and Nair found that genital dermatoses were present in 60% of participants, with atrophic vaginitis being the most prevalent (33.33%), followed by lichen sclerosus et atrophicus and lichen simplex chronicus (each at 15.55%) [59, 60]. Melasma was comparatively uncommon, reported in just 1.1–8.3% of females across the three studies. Additionally, among those with hair disorders in Pariath and Nair’s cohort, FPHL accounted for 34.24% [52]. In a more recent cohort, Jha and Selvaraj observed xerosis in 78% and pruritus in 46% of 150 postmenopausal women, supporting the view that dryness and itch are among the most frequently encountered findings in menopause [61]. Notably, 92% exhibited at least one dermatological manifestation ,with pigmentary changes reported in 64%, and hair thinning in 58%. All studies were conducted in India, limiting generalizability to other populations.

Summary: Evidence on dermatoses in menopause is limited to Indian cohorts. Eczema, genital dermatoses, and hair loss were common. Xerosis and pruritus were also highly prevalent, making dryness and itch leading complaints.

Discussion

This systematic review highlights the growing but still limited understanding of how menopause and MHT influence common dermatological conditions. Among all dermatoses evaluated, alopecia—FFA and FPHL—demonstrated the strongest and most consistent association with menopause. Both incidence and severity tended to increase post menopause, with earlier or surgically induced menopause linked to higher risk [11–17]. These associations may reflect estrogen’s role in maintaining follicular cycling and protecting against perifollicular inflammation. Declining estrogen and shifts in androgen/estrogen balance post menopause may tip the scalp environment toward androgen dominance, accelerating both FPHL and FFA progression. MHT was associated with an elevated risk of FFA; however, its effect on FPHL and hair loss overall remains unclear [22]. While some studies reported improvements in hair growth parameters, others noted alopecia as an adverse effect of certain hormone formulations, particularly those containing testosterone [28, 29]. These findings highlight the need for further research into the hormonal mechanisms underlying alopecia and how outcomes may vary by therapy type and alopecia subtype.

Most studies examining psoriasis reported symptoms either worsened or persisted after menopause. Earlier menopause and shorter reproductive lifespan were associated with increased risk, while later menopause appeared protective. Only one large cohort study found no relationship between menopausal timing and psoriasis risk [34]. This makes sense mechanistically as increased estrogen production in pregnancy has been associated with decreased T helper type 1 (Th1) and Th17 cytokine production, potentially contributing to psoriasis improvement [62]. However, findings on MHT were mixed; one study reported increased psoriasis risk across all durations of MHT use, while another observed a protective effect with combined conjugated estrogen and MPA [35, 36]. Estrogen-only therapy had no significant effect. Overall, the impact of MHT appears to be formulation-dependent and remains inconclusive.

Acne and rosacea typically improved after menopause, likely due to declining hormone levels. However, both conditions have been reported as adverse effects of MHT, especially with androgenic formulations. Because estrogen levels fall more sharply than testosterone, the resulting relative androgen excess may promote acne around the menopause transition, especially when compounded by androgenic MHT [63]. However, data on the impact of MHT on acne are lacking, representing an important gap in the literature.

HS demonstrated a variable response to menopause. Some studies reported persistent or worsening symptoms, while others showed improvement. While combined oral contraceptives have shown benefit in premenopausal females, no studies have examined the role of MHT in postmenopausal HS—highlighting a critical area for future investigation.

Melasma, commonly associated with estrogen-rich states, did not consistently improve after menopause. Some studies even reported increased extra-facial involvement in postmenopausal females, suggesting a more complex interplay of hormonal and environmental factors [50]. The potential impact of MHT on melasma remains unknown.

Despite increased interest, research on the prevalence and severity of skin disease in menopausal females remains sparse. The largest prevalence study identified eczema, urticaria, and papulosquamous disorders as most common [58–60]. However, its generalizability is limited by geographic and demographic homogeneity.

From a clinical practice standpoint, our findings suggest that dermatologists should consider menopausal status and hormone therapy history when evaluating changes in chronic skin disease. For example, awareness that alopecia often worsens post menopause or that certain MHT formulations may exacerbate acne, rosacea, and hair loss can help guide anticipatory counseling and treatment selection.

Equally important, menopause may compound the burden of conditions such as HS and psoriasis, both of which already carry elevated risks for metabolic and cardiovascular disease. This overlap of hormonal changes and systemic inflammation underscores the need for coordinated care across specialties to optimize outcomes. Yet, research on how menopause modifies these risks in affected populations remains limited, representing a critical gap for future study.

This review has several limitations. Common dermatological conditions such as seborrheic dermatitis, hirsutism, and xerosis were not included. Similarly, vulvovaginal disorders—including genitourinary syndrome of menopause (formerly vulvovaginal atrophy) and lichen sclerosis, both of which peak after menopause—were outside the scope of this review.

Interpretation is further complicated by confounding factors. Age is a central variable, as many cutaneous changes attributed to menopause may also reflect natural aging. Additional nonhormonal influences—such as weight gain, stress, and lifestyle changes around retirement—may contribute to dermatological outcomes in midlife women, making it difficult to isolate menopause-specific effects. Longitudinal studies with age-matched premenopausal controls are essential to address this challenge. Another limitation is the lack of racial and ethnic diversity in existing research. For example, the large cohort study on rosacea by Wu et al. included only White women, while prevalence data on dermatoses during menopause largely come from Indian cohorts, limiting generalizability. Conversely, melasma studies often involved ethnically mixed or undefined populations, potentially obscuring differential effects across skin types. Taken together, these limitations highlight the need for future research designed to disentangle hormonal from nonhormonal factors and to better capture diverse populations, including the differential impact of menopause and MHT across racial and ethnic groups.

Another important limitation is the reliance on outdated MHT regimens. Most studies evaluated formulations containing progestins such as MPA, which differ biologically and metabolically from micronized progesterone, more commonly used in contemporary therapy. These distinctions may have meaningful implications for dermatological outcomes. Future research should directly compare hormone types, dosages, and routes of administration to better define their effects on skin disease. In addition, interpretation of MHT effects across conditions is constrained by the observational design of most studies, heterogeneous outcome measures, and the absence of head-to-head comparisons between formulations, making it difficult to anticipate benefit or harm in specific dermatoses.

Conclusions

Public interest in menopause has risen sharply in recent years [64], but the medical field has been slow to respond—largely due to the lasting impact of the 2002 WHI findings, which linked HRT to increased breast cancer risk [6, 7]. Although the association was overly sensationalized and misrepresented, it led to a sharp drop in HRT/MHT use and long-term neglect of menopause education in medical training [3]. This knowledge gap has limited research on the effects of menopause across all aspects of skin health, including cutaneous disease. This systematic review highlights the complex and varied impact of menopause and MHT on common dermatoses, underscoring the significant role hormonal change may play in the onset, progression, and severity of certain skin conditions. With approximately 25 million females worldwide entering menopause each year, many will seek informed guidance on how this transition affects their skin [65]. Advancing understanding in this area can support more personalized and effective dermatological care for our patients in midlife and beyond.

Funding

No funding was received.

Declarations

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Conflict of Interests and Financial Disclosures

Dr S. Marmon chairs the American Academy of Dermatology's Menopause and Women's Health in Dermatology Quality Improvement Workgroup. All other authors report no conflicts of interest.

Author contributions

SM conceived of the project. KR and TBK. extracted the data. AE, AS, LF, and SM synthesized the data. KR, LF, BF, AS, and SM wrote the manuscript. All the authors have read and approved the final version of the manuscript.